Healthcare Provider Details

I. General information

NPI: 1861421281
Provider Name (Legal Business Name): STUART SHALIT D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 10/09/2024
Certification Date: 10/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 MADISON AVE SUITE B
MOUNT HOLLY NJ
08060-2055
US

IV. Provider business mailing address

120 MADISON AVE SUITE B
MOUNT HOLLY NJ
08060-2055
US

V. Phone/Fax

Practice location:
  • Phone: 609-261-4925
  • Fax: 609-261-9362
Mailing address:
  • Phone: 609-261-4925
  • Fax: 609-261-9362

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number25MB06634000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: